CONFIRMED RABIES CASE IN DOG IN FRANCE

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To:	Consultants in Communicable Disease NHS Trusts - Medical Directors (England) NHST/FT/007 - NHS FOUNDATION TRUSTS (ENGLAND) - MEDICAL DIRECTOR Primary Care Trusts - Directors of Public Health Primary Care Trusts - Medical Directors Public Health Link
Cc (Groups):	Chairman - Professional Executive Committee of PCT Regional Directors of Public Health Strategic Health Authorities (England) - Directors of Public Health Territorial CMOs
Fax To:

From:	Professor David R Harper CBE - Director General - Health Improvement and Protection - Department of Health
Date:	29 February 2008

Reference	CEM/CMO/2008/03
Category:	URGENT (cascade within 24 hours)

Title:	CONFIRMED RABIES CASE IN DOG IN FRANCE

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Please forward this message as directed within 24 hours
To: Directors of Public Health of PCTs to forward to:
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- Deputising services
- Project manager/Nurse lead in Walk in Centres
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To: Medical Directors of NHS Trusts and Foundation Trusts to forward to:
- Accident and emergency departments

To: Consultants in Communicable Disease Control

Cc:
- Regional Directors of Public Health
- Directors of Public Health of Strategic Health Authorities
- UK CMOs
- Chairmen of Professional Executive Committee

Confirmed rabies case in dog in France

The Health Protection Agency has just become aware of a case of confirmed rabies in a dog, diagnosed in France on the 26th February. Laboratory testing by the French authorities confirmed the dog has a canine viral strain of Moroccan origin. The French authorities have identified 4 potential risk areas (see below) where people may have been exposed to rabies.

GPs, A&Es and other health care professionals need to be vigilant for people reporting dog bites that occurred in the risk areas during the risk periods (see below). There may also be people who have presented previously who have been reassured because France is rabies free. Hence, doctors are especially asked to check records from patients presenting since the beginning of the risk period to review and reassess these cases.

The dog lived in Grandpuits in the Seine-et-Marne district (a small town approximately 30 miles SE of Paris). Investigations by French officials established that the dog was probably exposed to rabies via an illegally imported dog from Morocco through the chain of events outlined below:

Dog 1: [mixed breed Border collie] Imported from Morocco in late October to Gers, near to Toulouse and Aquitaine (in the south west France), via Tarbes (Haute Pyrenees). Died 12

^th

November.

Dog 2: [black cross Labrador] Contact with dog 1 in Gers, then travelled with family back to Grandpuits on 29

^th

November. Died 5

^th

January. This dog travelled to Lisieux, Normandy and was there from the 15

^th

to 18

^th

December.

Dog 3: [young mixed-breed female] in same family as dog 2, first symptoms appeared on 15

^th

February and died 19th February.

French health officials have investigated possible areas where all three dogs may have lived or visited and identified individuals who may have had contact with the infected dogs. Identified individuals have been offered preventative treatment.

The Health Protection Agency has been in close contact with the French authorities, and is advising the UK public that any person who has had had a significant exposure i.e., a bite, scratch, or lick to mucous membranes or broken skin, from any dog in the following areas during the relevant time period should seek prompt medical assessment from their GP or NHS Direct.

According to current information, the periods of possible exposure to rabies are:

Hautes-Pyrénées (Tarbes and surroundings), from the 25

^th

October 2007

Gers (Auch and surroundings), from the 1

^st

November 2007

Seine-et-Marne, environs of Grandpuits from the 15

^th

December 2007(see names of villages listed below)

Calvados (Lisieux and Thury Harcourt and their surroundings), from the 15

^th

December 2007

Current list of villages considered at-risk in Seine et Marne

Andrezel
Argentières
Aubepierre-Ozouer-Le-Repos
Bernay-Vilbert
Blandy
Bombon
Bréau
Champeaux
Chaumes-En-Brie
Clos-Fontaine
Courpalay

Courtomer
Crisenoy
Fontenailles
Fontenay-Tresigny
Fouju
Gastins
Grandpuits-Bailly-Carrois
Guignes
La Chapelle-Gauthier
La Chapelle-Iger
La Croix-En-Brie
Maison-Rouge

Mormant
Nangis
Pécy
Quiers
Rampillon
Rozay-En-Brie
Saint-Mery
Saint-Ouen-En-Brie
Vanvillé
Vaudoy-en-Brie
Verneuil-l’Etang
Vieux-Champagne

Doctors should seek expert advice and possible treatment for their patients as they would in any case of a dog bite where rabies may be involved, by contacting the HPA duty doctor on 020 8200 6868. People bitten by a dog during the dates and in the places indicated should be offered treatment to prevent rabies. Persons bitten by dogs in France outside of these times and places are not currently being advised to seek treatment. Biting is the most common way in which rabies is transmitted from dogs to humans, but there is also a slight risk of transmission from scratches or if the dog has licked a person on a cut, on the mouth, or around the eyes.

Further information on risk assessment and use of rabies vaccine and immunoglobulin is available from the Health Protection Agency (see http://www.hpa.org.uk/ for contact details or telephone 020 8200 6868).

To date France is considered to be free of terrestrial rabies. French authorities are yet to confirm whether this status will change. However until further information is available travellers to the affected areas of France are advised to avoid contact with animals whether possible and to seek early medical assessment in the case of bites, scratches or licks from dogs.

Additional Information: